Presentation (CTI)

OBJECTIVES: To quantify patient-related and health-system-related delays in TB diagnosis and treatment and to identify key determinants of these delays among adults receiving care at Kenyatta National Hospital (KNH).
METHODS: A descriptive cross-sectional study involving 128 smear-positive pulmonary TB patients was conducted in 2022. Participants aged ≥15 years were selected through systematic sampling. Data on socio-demographic factors, care-seeking pathways, and diagnostic intervals were collected through structured interviews. Delay durations were categorized using the median as the cut-off point. Descriptive statistics, chi-square tests, and logistic regression were used to determine predictors of patient and system delays. Statistical significance was set at p < 0.05.
RESULTS: Women constituted 51.2% of participants, with the largest age group being 40-49 years (32.3%). A substantial proportion (29.9%) sought medical care only after 2-3 months of symptoms. Distance to health facilities, socio-economic constraints, and health-worker-related factors were significantly associated with prolonged delay (p < 0.05). Many patients (66.9%) reported fear upon receiving a diagnosis, while 96.1% believed they should access treatment free of charge. Perceived community stigma was high (96.9%), and both patient behaviour and health-system processes were considered contributors to delayed care.
CONCLUSIONS: Significant patient-level and system-level delays persist at KNH, highlighting critical gaps in early TB detection and timely initiation of treatment. Strengthening diagnostic capacity, decentralizing services, enhancing patient awareness, and improving health-worker responsiveness are essential to accelerate TB case detection and align with national and global TB-control targets.